Healthcare Provider Details

I. General information

NPI: 1063986701
Provider Name (Legal Business Name): SIDDIQUE MEDICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 WEBSTER DR
PLANO TX
75075-6666
US

IV. Provider business mailing address

1611 BRYCE CANYON LN
ALLEN TX
75002-2696
US

V. Phone/Fax

Practice location:
  • Phone: 214-566-7714
  • Fax:
Mailing address:
  • Phone: 214-566-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: REZIUDDIN SIDDIQUE
Title or Position: OWNER
Credential: MD
Phone: 214-566-7714